Provider Demographics
NPI:1750477741
Name:SKAROFF, RICHARD MARK (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:MARK
Last Name:SKAROFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 ROOSEVELT BLVD.
Mailing Address - Street 2:SUITE 209
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-3038
Mailing Address - Country:US
Mailing Address - Phone:215-543-9300
Mailing Address - Fax:215-543-9313
Practice Address - Street 1:8001 ROOSEVELT BLVD.
Practice Address - Street 2:SUITE 209
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3038
Practice Address - Country:US
Practice Address - Phone:215-543-9300
Practice Address - Fax:215-543-9313
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027118E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1165500Medicaid
PA1165500Medicaid
PAB41917Medicare UPIN